Ovarian cancer

Question 1

What medication can reduce the risk of ovarian cancer?

Answer 1

Oral contraceptive pill (OCP)

Question 2

What age group is ovarian cancer rare in?

Answer 2

<30yrs

Question 3

What genetics/high risk families can be high risk of developing ovarian cancer?

Answer 3

HNPCC/Lynch syndrome
BRAC1
BRAC2

Question 4

What is the incessant ovulation theory in ovarian cancer?

Answer 4

Suggests that the risk of ovarian carcinoma increases as a result of the recurrent minor trauma to the ovarian surface epithelium that occurs during ovulation

Question 5

What are the signs/symptoms of ovarian cancer?

Answer 5

Often vague
Indigestion/early satiety/poor appetite
Altered bowel habit/pain
Bloating/discomfort/weight gain
Pelvic mass (pressure symptoms or asymptomatic)

Question 6

What are the diagnostic techniques for ovarian cancer?

Answer 6

Surgical/pathological
US abdomen/pelvis
CT
CA125

Question 7

What is a tumour marker for ovarian cancer?

Answer 7

CA 125

Question 8

What is CA 125

Answer 8

Glyco-protein antigen

Question 9

What benign conditions can CA 125 be raised in?

Answer 9

Menstruation
Endometriosis
PID
Liver disease
Recent surgery
Effusions

Question 10

What cancers can CA 125 be raised in?

Answer 10

Ovarian
Colon/pancreas
Breast

Question 11

What percentage of women with ovarian cancer have raised CA 125?

Answer 11

80%

Question 12

What is the RMI score?

Answer 12

Risk malignancy index

Question 13

What is the RMI for ovarian cancer?

Answer 13

RMI = U x M x CA 125

Question 14

What is the U and M in the RMI for ovarian cancer?

Answer 14

U = ultrasound evaluation
M = menopausal status

Question 15

What are ultrasound features you would look for when doing an RMI for ovarian cancer?

Answer 15

Multi-lobular
Solid areas
Bilateral
Ascites
Intra-abdominal

Question 16

What is the staging for ovarian cancer?

Answer 16

Stage 1-4

Question 17

What is stage 1 ovarian cancer?

Answer 17

Limited to ovaries with capsule intact

Question 18

What is stage 2 ovarian cancer?

Answer 18

One or both ovaries with pelvic extension

Question 19

What is stage 3 ovarian cancer?

Answer 19

One or both ovaries with peritoneal implants outside pelvis or + nodes

Question 20

What is stage 4 ovarian cancer?

Answer 20

Distant metastasis

Question 21

What are the two main options for treatment for ovarian cancer?

Answer 21

Surgery

Chemotherapy

Question 22

What are the surgery options for ovarian cancer?

Answer 22

Laparotomy
Total abdominal hysterectomy (TAH)
Bilateral salpingo-oophorectomy (BSO)

Question 23

What happens during a laparotomy for ovarian cancer?

Answer 23

Obtain tissue diagnosis
Stage disease
Disease clearance
Debulk disease

Question 24

What is the first line chemotherapy for ovarian cancer?

Answer 24

Platinum and taxane (Taxol)

Question 25

When is chemotherapy given for ovarian cancer?

Answer 25

Within 8 weeks of surgery Complete/partial response Cure unlikely Average response 2yrs

Question 26

What is the management if there is recurrence of ovarian cancer?

Answer 26

``` Chemotherapy Palliation Platinum >6mo ?Surgery Tamoxifen ```

Question 27

Why tamoxifen in ovarian cancer?

Answer 27

Keep any estrogens circulating in the woman's body from stimulating cancer cell growth

Question 28

Who is screened for ovarian cancer?

Answer 28

High risk women: cancer gene mutation carriers, 2+ relatives

Question 29

What can be screened for ovarian cancer?

Answer 29

Pelvic examination US ovaries CA 125

Question 30

What surgery can be recommended for women at high risk of ovarian cancer?

Answer 30

Prophylactic oophorectomy

Question 31

At what stage does ovarian cancer usually present?

Answer 31

Stage 3/4 disease

Question 32

What are the normal values of CA 125?

Answer 32

<46 U/mL

Question 33

What is the main type of ovarian cancer?

Answer 33

Epithelial

Question 34

What is the main type of epithelial ovarian cancer?

Answer 34

Serous

Question 35

What are the risk factors for ovarian cancer?

Answer 35

``` Low parity/infertility Early menarche Late menopause HRT Obesity Smoking Previous IBD Breast/bowel cancer Endometriosis Genetic Developed world ```

Question 36

What are protective factors for ovarian cancer?

Answer 36

OCP Childbearing Breast feeding Hysterectomy

Question 37

What is not present in ovarian cancer which you'd expect of a gynaecological cancer?

Answer 37

Vaginal discharge and blood

Question 38

What are some DD for ovarian cancer?

Answer 38

``` Benign ovarian tumours/cysts Fibroids Pelvic malignancies Endometriosis IBS/IBD Constipation Coeliac Gastroenteritis Diverticulitis ```

Question 39

Where does ovarian cancer typically spread to?

Answer 39

``` *Greater omentum Liver Lungs Bone Cerebrum Lymph nodes ```